Today, due to widespread engagement in sports and other physical activities, damage to ligaments, cartilage, and tendons in joints has become a relatively common phenomenon. Unfortunately, though this damage often requires surgical repair, the repair of some of these joints can be somewhat difficult.
Examples of such ligaments are the cruciate ligaments, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments of the human knee cooperate with other ligaments and soft tissue to provide static and dynamic stability to the knee joint. Often, the cruciate ligaments are ruptured or torn as a result of physical activity and, consequently, various surgical procedures have been developed for reconstructing the ACL and PCL, thereby restoring normal function to the knee.
For instance, many times, when a person's ACL and/or PCL is significantly damaged, the knee joint is repaired by substituting a harvested or synthetic replacement ligament for the damaged one. In these cases, the graft ligament is extended across the interior of the joint and its two opposite ends are anchored to the femur and tibia bones. Typically, these procedures involve forming tunnels in the femur and tibia bones, then extending the ends of the graft ligament, either part way or all the way, through these bone tunnels, and then securing these ends to the bones, usually by fastening them to either the side walls of the bone tunnels or the exterior surfaces of the bones. Once anchored in place, the graft ligament is able to cooperate with the surrounding tissues and thereby perform the functions of the damaged ACL or PCL.
In order to perform these procedures, surgeons typically use a drill guide to create the tunnels in the femur and tibia bones. These drill guide devices generally include a handle or other support means for holding the device next to the patient's body. Typically, these drill guide devices also include a “probe” arm having a tip that is adapted to be disposed within the knee, often at a location next to what is expected to be one end of the tunnel to be drilled (i.e. the spot where the drilling member that drills the tunnel will exit the bone). Usually, a guide sleeve is provided for directing a drill, or a guidewire for later guiding the drill, into position on the anterior surface of one of the bones surrounding the knee joint. This guide sleeve typically has its axis more or less aligned to intersect with the aforementioned probe tip and is generally slidable or variable in position relative to the support means.
In operation, these known drill guide devices are used by first placing the probe tip at or near a predetermined location on the bone. Next, the drill guide sleeve is adjusted relative to the probe arm so that one end of the guide sleeve is directed toward the appropriate position on the anterior surface of the bone. Once in place, the probe tip and guide sleeve are locked in position relative to each other by various means known in the art, as further explained below. Once the guide sleeve is adjusted and locked in position, a guidewire, often known as a K-wire, is slid through the guide sleeve and advanced through the bone. This K-wire defines the tunnel drilling axis. When the K-wire is seated in position on the bone, the drill guide sleeve is unlocked and removed, longitudinally, back along the K-wire. The rest of the drill guide device is then removed, leaving only the K-wire. At this point, a cannulated drill is slid over the K-wire to drill the tunnel in the bone.
Due to the complex interdependency between the ACL, the PCL, and the other knee ligaments, bones, and tissues, the precise positioning of the graft ligament relative to the surrounding bones is critical to the successful reconstruction of the knee joint. Specifically, the ability of the surgeon to precisely control the positioning and formation of the bone tunnels is of particular importance.
Accordingly, as noted above, these drill guide devices typically include a probe arm and a drill sleeve that are angularly displaceable relative to each other. Examples of such devices are disclosed in U.S. Pat. No. 4,672,957 to Hourahane; U.S. Pat. No. 4,722,331 to Fox; U.S. Pat. No. 4,781,182 to Purnell et al.; U.S. Pat. No. 5,112,337 to Paulos et al.; U.S. Pat. No. 5,154,720 to Trott et al.; and U.S. Pat. No. 5,163,940 to Bourque, U.S. Pat. No. 5,330,468 to Burkhart; U.S. Pat. No. 5,350,383 to Schmieding et al.; U.S. Pat. No. 5,458,602 to Goble et al.; U.S. Pat. No. 5,562,664 Durlacher et al.; U.S. Pat. No. 5,613,971 to Lower et al.; U.S. Pat. No. 5,643,273 to Clark; and U.S. Pat. No. 5,968,050 to Torrie, all of which are hereby incorporated herein by reference.
Typically, the probe arm and the part of the device that holds the drill sleeve, such as a handle, are connected by, or one is mounted on the other with, a mechanism facilitating this relative angular displacement. In most of these devices, this mechanism includes an arcuate piece along which, or through which, another piece can be ratcheted or slid, and subsequently, tightened or locked in a position where the appropriate angular displacement is achieved. Accordingly, the surgeon is able to guide the drilling sleeve against the anterior portion of the bone at a variety of angles by moving the part of the drill guide holding the sleeve arcuately relative to the probe arm. In this way, the operator of the drill guide is able to guide the sleeve against the bone at a particular desired angle for a particular surgical operation.
One disadvantage of these devices, however, is that they typically permit a certain degree of toggling. As a result, the accuracy of the device is reduced. However, as noted above, due to the complex interdependency between the various parts of the knee, precise positioning of the guidewire is crucial to a successful procedure.
Another disadvantage of these devices is that they tend to be difficult to manipulate. Once the probe arm is positioned on the bone, unnecessary movement of the device can cause the tip of the arm to change position. Moreover, excessive movement can even result in damage to the knee. Therefore, once the tip of the arm is in position, the surgeon will want to move the device as minimally as possible while selecting the appropriate angle for the drill sleeve. However, when using the aforementioned devices, it can be difficult for the surgeon, while trying to hold the device steady with one hand, to move the drill sleeve portion of the device to the appropriate angle and then hold it steady while locking it into position. Moreover, the fact that these devices typically employ a number of parts similarly increases the likelihood that undesired movement will occur while the device is being locked into position against the bone.
Another type of device that has been proposed includes a body having a plurality of angularly displaced sockets for receiving the probe, such as that disclosed in U.S. Pat. No. 4,920,958 to Walt et al, which is hereby incorporated herein by reference. However, this device has the disadvantage that, once the probe has been inserted into the knee and positioned on the bone, the angle of the wire guide relative to the probe cannot be changed without having to withdraw, reinsert, and reposition the probe.
What is desired, therefore, is an apparatus for guiding a drilling member into a bone that is easy to manipulate. What is further desired is an apparatus for guiding a drilling member into a bone that reduces undesired movement of the device. What is also desired is an apparatus for guiding a drilling member into a bone that does not needlessly damage the patient's knee.